Process for alleviating proliferative skin diseases

ABSTRACT

A process for alleviating proliferative skin diseases such as psoriasis, atopic dermatitis, etc. comprising administering to humans, or domesticated animals, topically and/or systemically a composition comprising a pharmaceutical carrier and at least one active compound selected from the groups, substituted alkyl zanthines, substituted thioxanthines, alone or in combination with a glucocorticoid.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a Division of Ser. No. 646,633 filed Jan. 5, 1976,and now U.S. Pat. No. 4,034,087; which was a continuation-in-part ofSer. No. 425,065, filed Dec. 12, 1973, now abandoned; and which was acontinuation-in-part of Ser. No. 324,012, filed Jan. 16, 1973, nowabandoned.

BRIEF DESCRIPTION OF THE INVENTION

This invention relates to pharmaceutical compositions for and a methodof treating psoriasis and related skin diseases characterized byepidermal cell proliferation. The compositions may be applied topicallyor by injection such that the composition enters the blood stream, orintralesionally, or intradermally, or sub-cutaneously or orally. Thetreatment may be either therapeutic or prophylactic.

DETAILED DESCRIPTION OF THE INVENTION

Humans and domesticated animals are afflicted with a wide variety ofskin disorders or diseases. This invention relates to the treatment ofthat portion of skin diseases which is characterized by epidermal cellproliferation, or division, and may also be associated with incompletetissue differentiation. Such diseases do not include carcinomas of theskin nor changes in skin cells during aging, or during the normal skinreplacement cycle. Psoriasis is the most serious of the skin diseaseswith which this invention is concerned. These skin diseases aredesignated, in this specification and in the claims as "proliferativeskin diseases" and other examples include atopic dermatitis,non-specific dermatitis, primary irritant contact dermatitis, allergiccontact dermatitis, lamellar ichthyosis, epidermolytic hyperkeratosis,pre-malignant sun-induced keratosis, non-malignant keratosis andseborrheic dermatitis in humans, and atopic dermatitis and mange indomesticated animals.

Heretofore, proliferative skin diseases have been generally accepted bymankind as an ongoing evil having degrees of severity variable withtime, with inherited skin traits and external factors but always havebeen recognized as unsightly, painful, morbid diseases. Over the historyof mankind innumerable medicines and treatments have been proposed,tried and used with varying degrees of success. However, no treatmentheretofore devised or pharmaceutical composition used has been entirelysuccessful.

The present day treatments of a commercial nature which are prescribedand used for the treatment of proliferative skin diseases include threeapproaches: (1) topical applications: coal tar derivatives, 5fluorouracil, vitamin A acid, glucocorticoids in high dosage(constituting a non-permissive concentration), bath oils andnon-specific emollient creams and ointments; (2) the systemicadministration: glucocorticoids and classic anti-cancer agents, forexample, methothrexate, hydroxyurea, azaribine, cyclophosphamide; (3)physical modalities; ultra violet light, x-irradiation, and in severecases, surgery.

While these treatments provide, in certain cases, some remission of theoriginal symptoms, each treatment suffers some defect, for example,temporary and/or incomplete mitigation of symptoms, rapid re-occurrenceof the disease when treatment is terminated, serious and sometimesirreversible damage (atrophy) resulting from the topical application forextended times of glucocorticoids, acute bone marrow suppression andcirrhosis of the liver resulting from the protracted use ofmethothrexate which may lead to death of the patient, and the causationof cancer by the application of anti-cancer drugs, x-irradiation, orultra violet rays.

Psoriasis is well-known to afflict two to three percent of the earth'spopulation and is considered by most to be one of man's most unsightly,painful, morbid diseases. Psoriasis is a complex disorder of manyvarieties and is not completely medically understood even thoughextensive research and effort has been expended in the attempt todetermine and identify its cause and to provide a cure. It is known thatthe epidermis of a psoriasis patient is characterized by excessive cellproliferation, incomplete terminal differentiation and glycogenaccumulation. Although many compositions and methods for alleviatingpsoriasis have been proposed and used, only certain of them have beensuccessful; even those considered successful usually alleviated thedisease only for temporary periods. There is still a need for improvedcompositions and methods for treating psoriasis.

Previously existent compositions and treatments for psoriasis haveprovided in certain cases some remission of the original symptoms, or atemporary cure, but each composition or treatment heretofore knownsuffers from some defect to some degree. For a treatment to constitute acure for psoriasis, it must be both safe and effective to cause anenduring remission of all the psoriasis lesions on the body to a degreesuch that they disappear and the skin assumes a normal appearance and ishealthy and functional on a continuing basis. Alleviation of psoriasisto a degree less than a complete cure is useful and desirable because atreatment which accomplishes an alleviation in a seriously afflictedpatient may be satisfactory to effect a substantially complete orpermanent cure in a less seriously afflicted patient.

The primary object of this invention is to provide a pharmaceuticalcomposition suitable for and a method of treating proliferating skindiseases. One of the more specific primary objectives of this inventionis to provide a pharmaceutical composition for administration topsoriasis patients which is both capable of alleviating psoriasis andsafe in application, even over an extended time period. Another objectof this invention is to provide a method for treatment of psoriasiswhich is capable of effecting alleviation of the psoriasis in a shorttime period. A further object is to provide a cure for psoriasis, i.e.,one which prevents a re-occurrence of the disease when the treatment isterminated.

In accordance with this invention it has been found that proliferativeskin diseases are alleviated, that is, the symptoms of the disease arenoticeably improved or become undetectable, by the treatment of theafflicted patient, or animal, with one or more of the pharmaceuticalcompositions described in detail hereinbelow.

For the purposes of this specification and the claims, a proliferativeskin disease is alleviated when there is a noticeable decrease in thethickness of a lesion to palpation, with or without residual redness, orresidual slightly dilated blood vessels or residual hyper- orhypo-pigmentation. For purposes of this invention and as claimed herein,psoriasis is alleviated when a scale-free psoriasis lesion is noticeablydecreased in thickness, or noticeably but incompletely cleared, orcompletely cleared; indications of such alleviation include restorationof cell proliferation rate, and/or terminal differentiation, and/orglycogen content to near normal levels.

The compositions of this invention may be applied topically or byinjection such that the composition enters the blood stream, orintradermally, intra- or peri-lesionally, or sub-cutaneously.

The term "topical" as employed herein relates to the use of the activeingredient incorporated in a suitable pharmaceutical carrier, andapplied at the site of the disease for exertion of local action.Accordingly, such topical compositions include those pharmaceuticalforms in which the compound is applied externally by direct contact withthe skin surface to be treated. Conventional pharmaceutical forms forthis purpose include ointments, lotions, pastes, jellies, sprays,aerosols, bath oils and the like. The term "ointment" embracesformulations (including creams) having oleaginous, absorption,water-soluble and emulsion-type bases, e.g., petrolatum, lanolin,polyethylene glycols, as well as mixtures thereof. It has been foundthat topical application with occlusion of an area larger than themedicated area produces improved results relative to non-occludedtopical application and is, therefore, the preferred method of topicaltreatment with the compositions of this invention.

Certain of the compositions of this invention advantageously includeskin penetrating adjuvants such as, for example, dimethyl sulfoxide,dimethyl acetamide, etc.

Injection "intradermally" refers to positioning the composition in thehigh dermis by needle injection, or by high pressure air injection.

Injection "intra- or peri-lesionally" refers to positioning thecomposition into the lesion or into the tissue adjacent to the lesion.

The compositions may be injected so as to reach the blood streamintramuscularly, subcutaneously, rectally by suppositories,sublingually, intravenously, orally, by inhalation, or by application tonon-diseased skin.

The best mode of practicing the process of this invention is to treatthe afflicted animal, or human, so as to cause a continuing release ofthe active compound at the afflicted site or sites, at a selected,controlled rate which is sustained for an extended time period. Forexample, epinephrine will be continuously released and providessustained epinephrine activity for 9-10 hours by employing an aqueoussuspension of crystalline epinephrine 1:200, in a sterile solutioncontaining 0.5% phenol, 0.5% sodium thioglycollate, 1% sodium ascorbate,and 25% glycerine in water. This suspension may be administeredsubcutaneously in a dosage of 0.1-0.3 cc. of the suspension. Epinephrineactivity is obtained substantially immediately from the epinephrine insuspension. Various modifications of the suspension ingredients,compatible with the particular active compound selected for injectionmay be made to obtain the desirable continuing and sustained activecompound activity at the site being treated. Moreover, appropriatesubstitutions for the above mentioned suspension ingredients may be madeto accommodate the selected active compound for topical or systemicadministration to the afflicted patient, and similar enhanced resultsare obtained from such applications when the active compound is releasedover an extended time period.

The compositions of this invention comprise a pharmaceutical carrier andabout 0.1% to about 15%, weight/volume, of at least one of the compoundsselected from the groups:

1. Xanthines of the formula ##STR1## wherein R and R₁ are selected fromthe group consisting of H, alkyl and hydroxyalkyl containing 1-7 carbonatoms, cycloalkyl containing 3-7 carbon atoms and aralkyl wherein thealkyl portion contains 1-7 carbon atoms, R₂ is H, alkyl (1-4), or acomplex with ethylenediamine, and Y is selected from the groupconsisting of H or thiol;

2. Thioxanthines of the formula ##STR2## wherein R₁ is selected from thegroup consisting of methyl, ethyl, propyl or --CH₂ --CH═CH₂ ; R₂ ismethyl, ethyl, propyl, --CH₂ CH═CH₂, isopropyl, isobutyl, CH₂ CCH₃ ═CH₂,pentyl, 3-methoxy-propyl, 2-methylbutyl, hexyl, benzyl, phenyl,phenethyl, or furfuryl; R₃ is selected from the group consisting ofhydrogen, methyl or ethyl;

3. A compound of the formula ##STR3## wherein R₁ is selected from thegroup consisting of lower alkyl of 1 to 7 carbon atoms, cycloalkyl of 3to 6 carbon atoms, phenyl or (R₄)_(n) -phenyl, (R₄)_(n) -phenyl-loweralkyl wherein R₄ is hydrogen, lower alkyl as defined above, halogen, andhydroxy-lower alkyl wherein the carbon chain is 1-3, n is 1 or 2, R₂ isselected from the group consisting of hydrogen or lower alkyl, asdefined above, R₃ is selected from the group consisting of hydrogen orlower alkyl as defined above and the physiologically acceptable acidaddition salts thereof; R₄ is phenyl or simply substituted phenyl.

4. A compound of the formula ##STR4## wherein R and R₁ are selected fromthe group consisting of hydrogen or lower alkyl of 1 to 3 carbon atoms,R₂ and R₃ are selected from the group consisting of hydrogen, loweralkyl of 1 to 4 carbon atoms, phenyl, benzyl, phenethyl,dialkylaminoalkyl in which alkyl is of 1-3 carbon atoms or takentogether R₂ and R₃ form a heterocyclic ring, such as pyrrolidine,piperazino, piperidino, methylaziridino, 2,3-dimethylaziridino,4-hydroxyethylpiperazino, and the pharmacologically acceptable acidaddition salts.

5. A compound of the formula ##STR5## wherein R and R₁ each is hydrogen,lower alkyl of 1-8 carbon atoms, benzyl or phenylethyl, R₂ is hydrogen,lower alkyl of 1-8 carbon atoms or phenyl, R₃ is hydrogen, lower alkyldefined as above or lower alkanoyl in which the acyl radical is of 1-8carbon atoms, providing that only one R is a phenyl containingsubstituent, and physiologically acceptable acid addition salts thereof,X represents hydrogen, lower alkyl, hydroxy-lower alkyl, phenyl,substituted phenyl, phenyl-lower alkyl or substituted phenyl-loweralkyl, Y represents lower alkyl, phenyl, hydroxy-lower alkyl,substituted phenyl, phenyl-lower alkyl or substituted phenyl-lower alkyland together X and Y are cycloalkyl.

6. A compound of the formula ##STR6## wherein R and R₁ are selected fromthe group consisting of hydrogen or lower alkyl of 1 to 3 carbon atoms,R₂ and R₃ are selected from the group consisting of hydrogen, loweralkyl of 1 to 4 carbon atoms, phenyl, benzyl, phenethyl,dialkylaminoalkyl in which alkyl is 1-3 carbon atoms or taken togetherR₂ and R₃ form a heterocyclic ring, such as pyrrolidino, piperazino,piperidino, methylaziridino, 2,3-dimethylaziridino,4-hydroxyethylpiperazino, and the pharmacologically acceptable acidaddition salts, and R₄ is lower alkyl, cyclo-lower alkyl, phenyl,hyroxyphenyl or hydroxy-lower alkylphenyl.

7. A compound of the formula ##STR7## wherein R₁ is lower alkyl of 1-7carbon atoms, phenyl, benzyl or phenethyl and R₂ is hydrogen or loweralkyl.

8. A compound of the formula ##STR8## wherein R is hydrogen or alkyl ofup to 12 carbon atoms, R₁ is hydrogen, lower alkyl as defined above,meta- or para- R₄, R₅ -benzoyl, phenyl, benzyl or phenethyl, R₂ ishydrogen, lower alkyl defined as above, phenyl, benzyl or phenethyl, R₃is lower alkyl as above, benzyl or phenethyl, R₄ and R₅ each ishydrogen, halogen, methyl or methoxy, and physiologically acceptableacid addition salts thereof;

9. A compound selected from the group consisting of compoundscharacterized by the formula ##STR9## wherein R is halogen, hydrogen,lower alkyl and lower alkoxy; R₂, R₃ and R₄ taken independently of eachother are hydrogen, lower alkoxy or hydroxy-lower alkoxy and providedthat R₂, R₃ and R₄ taken independently of each other represent at leastone oxygenated substituent; or R, R₂, R₃ and R₄ taken as an adjacentpair is methylenedioxy and the optical antipodes thereof;

10. A compound of the formula ##STR10## where R is hydrogen or --CH₂CHOHCH₂ OH, X is lower alkyl of from 1 to 8 carbon atoms, lower alkoxyof from 1 to 8 carbon atoms, chloro, bromo --CH₃, NO₂, Y is chloro,bromo, --CH₃, NO₂, lower alkyl of from 1 to 8 carbon atoms, Z ishydrogen, halogen, CF₃, lower alkyl of from 1 to 8 carbon atomsinclusive;

11. A compound of the formula ##STR11## where R₁ is hydroxy, ##STR12##and R₁ and R₂ taken together can be ##STR13##

12. A compound of the formula ##STR14## wherein R₁ is hydrogen ormethoxy

R₂ is ##STR15##

R₃ is hydrogen, methyl, phenyl or ##STR16##

R₄ is hydrogen, hydroxy ##STR17##

13. A compound of the formula ##STR18## X ═ N--R₁ ; wherein R₁ is##STR19## n = 1-3, R₂ and R₃ are H or methyl or X ═ C ═ R₄ wherein R₄ is##STR20## n = 1-3 and R₅ and R₆ = H or methyl;

14. and at least one number selected from the group consisting of

Pentylenetetrazole

Methylphenidate

Bunamidine

Pyrvinium pamoate

Meprobamate

Phenacemide

Dipyridamol

Indomethacin

Chlordiazopoxide

Nicotinamide

Diazepam

Disodium chromoglycate

Levamisole

Diazoxide

Aldosterone

Nigroglycerine

Amyl nitrate

Sodium nitrate

Isosorbide dinitrate

Nicotinic acid

Cyclandelate

Erythritol tetra-nitrate

Pentaerythritol tetra-nitrate

Minoxidil and

Quazodine

said compounds being in association with a pharmaceutical carrierwherein the concentration of said active component is effective toalleviate a proliferative skin disease.

The compositions of this invention may be employed in conjunction withglucocorticoids. The expression "glucocorticoids" refers to a naturallyoccurring product of the adrenal cortex, or a synthetic analog thereofpossessing anti-inflammatory activity and minimal or nomineralocorticoid activity or sex steroid activity. Of the naturalglucocorticoids, one may use for example, hydrocortisone or thesynthetic glucocorticoids such as methyl prednisolone acetate(Prednisone) for oral application or triamcinolone for topical therapy.The glucocortcoids should be employed in minor amounts or "permissivedosage." The expression "permissive dosage" for glucocorticoids refersto a quantity which minimally supplements the natural output of adrenalcortical glucocorticoids in a normal person and which dosageadministered, alone, has no perceptible effect on proliferative skindiseases.

The quantity of the active compound to be used in the compositions ofthis invention for administration topically, parenterally orsystemically ranges from about 0.1% to about 15% weight/volumetopically; from about 0.1% to about 10% w/v parenterally; and for oraldosage forms the % amount of active ingredient is determined by thephysical characteristics of the carrier with regard to manufacturingrequirements and elegance.

The compositions of the present invention are presented for systemicadministration to humans and animals in unit dosage forms, such astablets, capsules, pills, powders, granules, sterile parenteralsolutions or suspensions, and oral solutions or suspensions, andoil-water emulsions containing suitable quantities of one or more of theactive compounds above described.

For oral administration either solid or fluid unit dosage forms can beprepared. For preparing solid compositions such as tablets, theprincipal active ingredient is mixed with conventional ingredients suchas talc, magnesium stearate, dicalcium phosphate, magnesium aluminumsilicate, calcium sulfate, starch, lactose, acacia, methylcellulose, andfunctionally similar materials as pharmaceutical diluents or carriers.The tablets can be laminated or otherwise compounded to provide a dosageform affording the advantage of prolonged or delayed action orpredetermined successive action of the enclosed medication. For example,the tablet can comprise an inner dosage and an outer dosage component,the latter being in the form of an envelope over the former.

Alternatively, the two component system can be utilized for preparingtablets containing two or more incompatible active ingredients. Wafersare prepared in the same manner as tablets, differing only in shape andthe inclusion of sucrose or other sweetener and flavor. In theirsimplest embodiment, capsules, like tablets, are prepared by mixing theactive compound or compounds with an inert pharmaceutical diluent andfilling the mixture into a hard gelatin capsule or appropriate size. Inanother embodiment, capsules are prepared by filling hard gelatincapsules with polymeric acid coated beads containing the active compoundor compounds. Soft gelatin capsules are prepared by machineencapsulation of a slurry of the active compound or compounds with anacceptable vegetable oil, light liquid petrolatum or other inert oil.

Fluid unit dosage forms for oral administration such as syrups, elixirs,and suspensions can be prepared. The water-soluble forms can bedissolved in an aqueous vehicle together with sugar, aromatic flavoringagents and preservatives to form a syrup. An elixir is prepared by usinga hydro-alcoholic (ethanol) vehicle with suitable sweeteners such assugar and saccharin, together with an aromatic flavoring agent.

Suspensions can be prepared of the insoluble forms with a syrup vehiclewith the aid of a suspending agent such as acacia, tragacanth,methylcellulose and the like.

Topical ointments can be prepared by dispersing the active compound orcompounds in a suitable ointment base such as petrolatum, lanolin,polyethylene glycol, mixtures thereof, and the like. Advantageously, theactive compound or compounds is finely divided by means of a colloidmill utilizing light liquid petrolatum as a levigating agent prior todispersing in the ointment base. Topical creams and lotions are preparedby dispersing the active compound or compounds in the oil phase prior tothe emulsification of the oil phase in water.

For parenteral administration the dosage forms are prepared utilizingthe active compound or compounds and a sterile vehicle, water beingpreferred. The compound, depending on the form and concentration used,can be either suspended or dissolved in the vehicle. In preparingsolutions, a water-soluble form of the compound can be dissolved inwater for injection and filter sterilized before filling into a suitablevial or ampul and sealing. Advantageously, adjuvants such as a localanesthetic, preservative and buffering agents can be dissolved in thevehicle. To enhance the stability, the composition can be frozen afterfilling into the vial and the water removed under vacuum. The drylyophilized powder is then sealed in the vial and an accompanying vialof water for injection is supplied to reconstitute the liquid prior touse. Parenteral suspenisons are prepared in substantially the samemanner except that the compound is suspended in the vehicle instead ofbeing dissolved and sterilization cannot be accomplished by filtration.The compound can be sterilized by exposure to ethylene oxide beforesuspending in the sterile vehicle. Advantageously, a surfactant orwetting agent is included in the composition to facilitate uniformdistribution.

For parenteral or systemic administration of the compositions of thisinvention, the usual dosage of the selected active compound, orcompounds, should be employed.

The compositions of this invention may include one or more of the aboveidentified active compounds in a single composition or the method of theinvention may be practiced by the administration of a plurality ofcompositions, each of which contains a single or a plurality of activecompounds. In certain cases, the method of the invention may involve theadministration of compositions containing a single active compound or amixture of active compounds by a plurality of the forms of theadministration, for example by a combination of oral and/or injectionand/or topical application, etc.

In other cases the method of this invention is advantageously practicedby combining the administration forms in a time spaced sequence, forexample, by using systemic application of one or more of thecompositions for a time period and then applying one or morecompositions topically, or by injection while continuing the systemicapplication, etc.

The following examples identify certain compositions which typify themanner of combining selected active compounds with a pharmaceuticalcarrier for use in the process of treatment of proliferative skindiseases as above generally described, but they are not intended torepresent the limits of either the compositions of or the process ofthis invention which is defined in the claims.

EXAMPLE 1 Capsules

One thousand two-piece hard gelatin capsules for oral use, eachcontaining 200 mg. of 1-methyl-3-isobutyl-xanthine are prepared from thefollowing types and amounts of materials:

1-Methyl-3-isobutyl-xanthine: 50 gm.

Corn starch: 250 gm.

Talc: 75 gm.

Magnesium stearate: 2.5 gm.

The materials are thoroughly mixed and then encapsulated in the usualmanner.

The foregoing capsules are useful for the systemic treatment ofpsoriasis in adult humans by the oral administration of 1 capsule every6 hours.

Using the procedure above, capsules are similarly prepared containing in25, 75, and 100 mg. amounts by substituting 25, 75, and 100 gm. of1-methyl-3-isobutyl-xanthine for the 50 gm. used above.

EXAMPLE 2 Capsules

One thousand two-piece hard gelatin capsules for oral use, eachcontaining 100 mg. of 1-methyl-3-isobutyl-xanthine are prepared from thefollowing types and amounts of ingredients:

1-Methyl-3-isobutyl-xanthine: 100 gm.

Corn starch: 250 gm.

Talc: 75 gm.

Magnesium stearate: 2.5 gm.

The ingredients are thoroughly mixed and then encapsulated in the usualmanner.

The foregoing capsules are useful for the systemic treatment ofpsoriasis in adult humans by the oral administration of 1 capsule fourtimes a day.

EXAMPLE 3 Tablets

One thousand tablets for oral use, each containing 50 mg. of1-methyl-3-isobutyl-xanthine are prepared from the following types andamounts of materials:

1-Methyl-3-isobutyl-xanthine: 50 gm.

Lactose: 125 gm.

Corn starch: 65 gm.

Magnesium stearate: 7.5 gm.

Light liquid petrolatum: 3 gm.

The ingredients are thoroughly mixed and slugged. The slugs are brokendown by forcing through a number sixteen screen. The resuiting granulesare then compressed into tablets, each tablet containing 50 mg. of1-methyl-3-isobutyl-xanthine.

The foregoing tablets are useful for systemic treatment of psoriasis inadult humans by oral administration of 1 tablet every 6 hours.

EXAMPLE 4 Oral syrup

One thousand cc. of an aqueous suspension for oral use, containing ineach 5 cc. dose 100 mg. of 1-methyl-3-isobutyl-xanthine is prepared fromthe following types and amounts of ingredients:

1-Methyl-3-isobutyl-xanthine: 40 gm.

Citric acid: 2 gm.

Benzoic acid: 1 gm.

Sucrose: 700 gm.

Tragacanth: 5 gm.

Lemon oil: 2 cc.

Deionized water q.s.: 1000 cc.

The citric acid, benzoic acid, sucrose, tragacanth, and lemon oil aredispersed in sufficient water to make 850 cc. of solution the1-methyl-3-isobutyl-xanthine is stirred into the syrup until uniformlydistributed. Sufficient water is added to make 1000 cc.

The composition so prepared is useful in the systemic treatment ofpsoriasis in adult humans at a dose of 1 teaspponful 4 times a day.

EXAMPLE 5 Parenteral solution

A sterile aqueous solution for intramuscular use, containing in 1 cc. 50mg. of 1-methyl-3-isobutyl-xanthine is prepared from the following typesand amounts of materials:

1-Methyl-3-isobutyl-xanthine: 50 gm.

Lidocaine hydrochloride: 4 gm.

Methylparaben: 2.5 gm.

Propylparaben: 0.17 gm.

Water for injection q.s.: 1000 cc.

The ingredients are dissolved in the water and the solution sterilizedby filtration. The sterile solution is filled into vials and the vialssealed.

The composition is useful in the systemic treatment of psoriasis at adose of 1 cc. I.M. 4 times a day.

EXAMPLE 6 Parenteral solution

A sterile aqueous solution for intradermal use, containing in 1 cc. 15mg. of 1-methyl-3-isobutyl-xanthine is prepared from the following typesand amounts of ingredients:

1-Methyl-3-isobutyl-xanthine: 15 gm.

Sodium chloride 10% Solution q.s.

Water for injection q.s.: 1000 cc.

The 1-methyl-3-isobutyl-xanthine is added to the water and sufficientsodium chloride added to form an isotonic solution and the solutionsterilized by filtration.

The sterile solution is administered intradermally by high pressureinjection for treatment of psoriasis.

EXAMPLE 7 Topical ointment

One thousand gm. of 10% ointment is prepared from the following typesand amounts of ingredients:

1-Methyl-3-isobutyl-xanthine: 100 gm.

Liquid petrolatum (heavy): 250 gm.

Wool fat: 200 gm.

White petrolatum q.s.: 1000 gm.

The white petrolatum and wool fat are melted and 100 gm. of liquidpetrolatum added thereto. The 1-methyl-3-isobutyl-xanthine added to theremaining liquid petrolatum and the mixture milled until the powder isfinely divided and uniformly dispersed. The powder mixture is stirredinto the white petrolatum mixture and stirring continued until theointment congeals.

The foregoing ointment is usefully applied topically to the skin ofanimals for the treatment of mange.

EXAMPLE 8 Cream

One thousand grams of a topical cream are prepared from the followingtypes and amounts of ingredients:

1-Methyl-3-isobutyl-xanthine: 50 gm.

Tegacid Regular*: 150 gm.

Spermaceti: 100 gm.

Propylene glycol: 50 gm.

Polysorbate 80: 5 gm.

Methylparaben: 1 gm.

Deionized water q.s.: 1000 gm.

The Tegacid and spermaceti are melted together at a temperature of70°-80° C. The methylparaben is dissolved in about 500 gm. of water andthe propylene glycol, polysorbate 80, and 1-methyl-3-isobutyl-xanthineare added in turn, maintaining a temperature of 75°-80° C. Themethylparaben mixture is added slowly to the Tegacid and spermacetimelt, with constant stirring. The addition is continued for at least 30minutes with continued stirring until the temperature has dropped to40°-45° C. The pH of the final cream is adjusted to 3.5 by adding 2.5gm. of citric acid and 0.2 gm. of dibasic sodium phosphate dissolved inabout 50 gm. of water. Finally, sufficient water is added to bring thefinal weight to 1000 gm. and the preparation stirred to maintainhomogeneity until cooled and congealed.

The foregoing composition is useful for the treatment of psoriasis byapplying to the lesions with occulsive bandage.

EXAMPLE 9

1-methyl-3-isobutyl-xanthine: 1000 gm.

Cetyl alcohol: 600 gm.

Stearyl alcohol: 600 gm.

Aerosol OT: 150 gm.

White petrolatum: 3000 gm.

Propylene glycol: 1000 ml.

Distilled water q.s.: 10,000 gm.

The 1-methyl-3-isobutyl-xanthine is mixed with the white petrolatum andstirred with a melt of the alcohols and propylene glycol. The aerosol OTis dissolved in 5000 cc. of water and an emulsion formed with thepetrolatum mix, sufficient water being added to make 10,000 grams.

The cream is applied to psoriatic lesions twice daily with occlusivebandage.

Optionally, following the procedure of the preceding example,substituting 2,000 grams of dimethylacetamide for 2000 grams of water acomposition is obtained providing better penetration of the activeingredient into the skin.

EXAMPLE 10 Capsules

One thousand two-piece hard gelatin capsules for oral use, eachcontaining 25 gm. of 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone areprepared from the following types and amounts of materials:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 25 gm.

Corn starch: 250 gm.

Talc: 75 gm.

Magnesium stearate: 2.5 gm.

The materials are thoroughly mixed and then encapsulated in the usualmanner.

The foregoing capsules are useful for the systemic treatment ofpsoriasis in adult humans by the oral administration of 1 capsule every4 hours.

Using the procedure above, capsules are similarly prepared containing in5, 10, and 100 mg. amounts by substituting, 5, 10, and 100 gm. of4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone for the 25 gm. used above.

EXAMPLE 11 Capsules

One thousand two-piece hard gelatin capsules for oral use, eachcontaining 25 mg. of 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone areprepared from the following types and amounts of ingredients:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 25 gm.

Corn starch: 250 gm.

Talc: 75 gm.

Magnesium stearate: 2.5 gm.

The ingredients are thoroughly mixed and then encapsulated in the usualmanner.

The foregoing capsules are useful for the systemic treatment ofpsoriasis in adult humans by the oral administration of 1 capsule twicea day.

EXAMPLE 12 Tablets

One thousand tablets for oral use, each containing 10 mg. of4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone are prepared from thefollowing types and amounts of materials:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 50 gm.

Lactose: 125 gm.

Corn starch: 65 gm.

Magnesium stearate: 7.5 gm.

Light liquid petrolatum: 3 gm.

The ingredients are thoroughly mixed and slugged. The slugs are brokendown by forcing through a number sixteen screen. The resulting granulesare then compressed into tablets, each tablet containing 10 mg. of4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone.

The foregoing tablets are useful for systemic treatment of psoriasis inadult humans by oral administration of 1 tablet every 4 hours.

EXAMPLE 13 Oral syrup

One thousand cc. of an aqueous suspension for oral use, containing ineach 5 cc. dose 25 mg. of 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinoneis prepared from the following types and amounts of ingredients:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 5 gm.

Citric acid: 2 gm.

Benzoic acid: 1 gm.

Sucrose: 700 gm.

Tragacanth: 5 gm.

Lemon oil: 2 cc.

Deionized water q.s.: 1000 cc.

The citric acid, benzoic acid, sucrose, tragacanth, and lemon oil aredispersed in sufficient water to make 850 cc. of solution. The4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is stirred into the syrupuntil uniformly distributed. Sufficient water is added to make 1000 cc.

The composition so prepared is useful in the systemic treatment ofpsoriasis in adult humans at a dose of 1 teaspoonful 4 times a day.

EXAMPLE 14 Parenteral solution

A sterile aqueous solution for intramuscular use, containing 1 cc. 5 mg.of 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is prepared from thefollowing types and amounts of materials:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 5 gm.

Lidocaine hydrochloride: 4 gm.

Methylparaben: 2.5 gm.

Propylparaben: 0.17 gm.

Water for injection q.s.: 1000 cc.

The ingredients are dissolved in the water and the solution sterilizedby filtration. The sterile solution is filled into vials and the vialssealed.

The composition is useful in the systemic treatment of psoriasis at adose of 1 cc. I.M. 4 times a day.

EXAMPLE 15 Parenteral solution

A sterile aqueous solution for intradermal use, containing in 1 cc. 5mg. of 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is prepared fromthe following types and amounts of ingredients:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 5 gm.

Sodium chloride 10% Solution q.s.

Water for injection q.s.: 1000 cc.

The 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is added to the waterand sufficient sodium chloride added to form an isotonic solution andthe solution sterilized by filtration.

The sterile solution is administered intradermally by high pressureinjection for treatment of psoriasis.

EXAMPLE 16 Topical ointment

One thousand gm. of 10% ointment is prepared from the following typesand amounts of ingredients:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 100 gm.

Liquid petrolatum (heavy): 250 gm.

Wool fat: 150 gm.

White petrolatum q.s.: 1000 gm.

The white petrolatum and wool fat are melted and 100 gm. of liquidpetrolatum added thereto. The4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is added to the remainingliquid petrolatum and the mixture milled until the powder is finelydivided and uniformly dispersed. The powder mixture is stirred into thewhite petrolatum mixture and stirring continued until the ointmentcongeals.

The foregoing ointment is usefully applied topically to the skin ofanimals for the treatment of mange.

EXAMPLE 17 Cream

One thousand grams of a topical cream are prepared from the followingtypes and amounts of ingredients:

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 50 gm.

Tegacid Regular*: 150 gm.

Spermaceti: 100 gm.

Propylene glycol: 50 gm.

Polysorbate 80: 5 gm.

Methylparaben: 1 gm.

Deionized water q.s.: 1000 gm.

The Tegacid and spermaceti are melted together at a temperature of70°-80° C. The methylparaben is dissolved in about 500 gm. of water andthe propylene glycol, polysorbate 80, and4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone are added in turn,maintaining a temperature of 75°-80° C. The methylparaben mixture isadded slowly to the Tegacid and spermaceti melt, with constant stirring.The addition is continued for at least 30 minutes with continuedstirring until the temperature has dropped to 40°-45° C. The pH of thefinal cream is adjusted to 3.5 by adding 2.5 gm. of citric acid and 0.2gm. of dibasic sodium phosphate dissolved in about 50 gm. of water.Finally, sufficient water is added to bring the final weight to 1000 gm.and the preparation is stirred to maintain homogeneity until cooled andcongealed.

The foregoing composition is useful for the treatment of psoriasis byapplying to the lesions with occlusive bandage.

EXAMPLE 18

4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone: 1000 gm.

Cetyl alcohol: 600 gm.

Stearyl alcohol: 600 gm.

Aerosol OT: 150 gm.

White petrolatum: 3000 gm.

Propylene glycol: 1000 ml.

Distilled water q.s.: 10,000 gm.

The 4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone is mixed with thewhite petrolatum and stirred with a melt of the alcohols and propyleneglycol. The aerosol OT is dissolved in 5000 cc. of water and an emulsionformed with the petrolatum mix, sufficient water being added to make10,000 grams.

The cream is applied to psoriatic lesions twice daily with occlusivebandage.

Optionally, following the procedure of the preceding example,substituting 2,000 grams of dimethylacetamide for 2,000 grams of water acomposition is obtained providing better penetration of the activeingredient into the skin.

EXAMPLE 19

Following the procedure of the preceding Examples 1 to 18, inclusive,substituting a therapeutic dosage amount each of1-methyl-3-isobutyl-xanthine, 6-thio theophylline,1,6-dimethyl-1,6-dihydro-dipyrazolo(3,4-b:3',4'-d)pyridin-3-one,4-dimethylamino-5-methoxycarbonyl-3-methylisoxayolo(5,4-b)pyridine,5-ethoxycarbonyl-4-(2-tertiarybutylhydrazino)-3-methylisoxayolo-(5,4-b)pyridine,5-acetyl-4-piperazino-3-methylisoxayolo-(5,4-b)pyridine,5,6,8-trimethyldipyriazolo(3,4-b:3',4'-d)pyridin-3(2H)-one,4-ethoxy-1-ethyl-3-methyl-1H-pyrazolo(4,3-c)pyridine-7-carboxylic acidethyl ester, 4-[3-(n-butoxy)-4-methoxybenzyl]2-imidazolidinone,glyceryl-2-(2,6-dimethylanilino)nicotinate,1-oxo-2-acetonylidenebenzo(b)thiophen,N-[1-(pyrollidino)ethyl]-2-phenyl-5-methoxyindole, imipramine for the4(3-butoxy-3-methoxybenzyl)-2-imidazolidinone, compositions are preparedwhich are useful for the treatment of psoriasis.

EXAMPLE 20

The compositions prepared in the preceding examples 1 through 19,inclusive, can similarly be administered for treatment of atopicdermatitis, non-specific dermatitis, basal and squamous cell carcinomasof the skin, lamellar ichthyosis, epidermolytic hyperkeratosis,premalignant sun induced keratosis, non-malignant keratosis, acne, andseborrheic dermatitis in humans and atopic dermatitis and magne indomesticated animals.

EXAMPLE 21

Advantageously, following the therapy of Examples 1 to 19, inclusive,additional benefits can be obtained with concurrent or sequential oraladministration of 20 mg. of prednisone twice a week.

EXAMPLE 22

Seventeen psoriasis patients were selected and used in the clinicalstudy consisting of the application four times per day on two selectedlesions on each patient of a cream, and the same cream containing 1% RO20-1724*, w/v, over a 4-week period. Neither the doctor nor the patientwas aware of which of the cream samples contained the active ingredientRO 20-1724. The cream was applied in a light layer to the entire surfaceof the lesion, with or without slight rubbing to make the overlying filmuniform and then the coated lesion was covered with a bandage, i.e., aplastic bandage having minimal porosity for air passage such that thelesion was substantially isolated from air at all times, except duringapplication.

Examination of the psoriatic lesions was made by three doctors, each ofwhom made independent appraisals of the appearance of the lesion at itscenter and at the edge and assigned a rating to the condition thereofusing 0 or 1 to mean no change in the appearance, a 2 or 3 meaning animprovement, that is, an alleviation of the psoriatic lesion as toredness or degree of scaling, or both; when the evaluation of a patientby 2 of the doctors was not the same, the lower score was used forstatistical analysis.

The selection of lesion location on each patient was one lesion on theleft side of the body and the other lesion on the right side of the bodyand the evaluations of appearance of the lesions are recorded in TableI, left or right; the right-hand column of Table I contains the code forthe portion of the body of each patient, i.e., left or right, whichreceived the cream containing the RO 20-1724 compound, and the resultscan be correlated directly for the two-week evaluation and the four-weekevaluation.

                  Table I                                                         ______________________________________                                        2nd              4th Week                                                     Week Evaluation  Evaluation RO 20-1724                                        Pat- Right     Left      Right   Left                                         ient C      E      C    E    C    E    C    E    Site                         ______________________________________                                        1    2      1      3    2    0    0    3    0    Left                         2    3      2      0    0    3    3    0    0    Right                        3    3      2      1    1    3    3    0    0    Right                        4    2      2      2    2    1    1    3    2    Left                         5    0      0      1    1    0    0    0    0    Left                         6    1      1      1    1    3    2    1    1    Right                        7    3      3      2    2    3    3    1    1    Right                        8    1      0      2    1    0    0    2    1    Left                         9    2      1      0    0    --   --   --   --   Right                        10   1      1      1    1    3    2    1    1    Right                        11   1      1      0    0    2    1    1    1    Left                         12   --     --     --   --   --   --   --   --   Left                         13   0      0      0    0    0    0    0    0    Right                        14   0      0      0    0    0    2    0    0    Right                        15   0      0      2    1    0    0    2    2    Left                         16   2      1      0    0    3    1    0    0    Left                         17   1      1      2    2    --   --   --   --   Left                         ______________________________________                                         C Center of lesion                                                            E Edge of Lesion                                                              O the circled ratings are those related to the RO 20 site                     Improved rating - 2 or 3                                                      Unimproved rating - 0 or 1                                               

Of the original 17 patients who entered the study, 14 were included inthe second week evaluation analysis, and 12 in the analysis of fourthweek evaluations.

No. 14 and No. 16 were not included at all, on the basis of theirnon-conformance to the protocol, e.g., not occluding, not returning forevaluation until 3 weeks instead of 2 and not applying the creamregularly.

No. 12 requested to be removed from the study at the time of this firstevaluation; the lesions couldn't be evaluated at that time because hehad not been using the occlusion.

No. 9 and No. 17 also requested to be removed soon after the firstevaluation because their untreated psoriasis was flaring. They areincluded in the 2nd week analysis, because they both applied the creamand occluded the lesions for the two weeks they were involved.

Based upon the results set forth in the above Table I, it is apparentthat there were statistically significantly more improved lesionstreated with RO 20-1724 for both the center and edge at the 4th week.The center was also significantly improved with RO 20-1724 at the secondweek. This double blind clinical evidence on psoriatic humans provesthat d,l-4-(3-butyxy-4-methoxybenzyl)-2-imidazolidinone functions toalleviate proliferative skin diseases, specifically psoriasis. Sincepsoriasis is the most difficult of the proliferative skin diseases toalleviate, this test demonstrates that the tested compound has utilityin alleviating proliferative skin diseases as that term is definedabove.

An improved form of this invention has now been found whereby psoriasismay be alleviated in a shorter time and to a greater than expecteddegree than obtainable by the processes described hereinabove. Thisimproved invention comprises the concurrent administration to anafflicted human or animal of a composition comprising active compoundsin association with a pharmaceutical carrier wherein said compounds arepresent in an amount in the range of about 0.1% to about 10% w/v, thecomposition containing at least one active compound selected from eachof two groups.

The first group of active compounds consists of isoproterenol,salbutamol, epinephrine, nor-epinephrine, ephedrine, and prostaglandinE₁ and E₂. Prostaglandin E-type compounds and their esters are known inthe art. See, for example, Bergstrom S., et al. P'Col Reviews 20:1(1968) for PGE₁, PGE₂.

The second group of active compounds consists of 1-methyl-3-isobutylxanthine, caffeine, theophylline, diazepam, papaverine,1-ethyl-4-(isopropylidenehydrazino)-1H-pyrazolo-(3,4-b)-pyridine-5-carboxylicacid, ethyl ester, HCl, and a compound having the formula: ##STR21##wherein R is halogen, hydrogen, lower alkyl and lower alkoxy; R₂, R₃ andR₄ taken independently of each other are hydrogen, lower alkoxy orhydroxy-lower alkoxy and provided that R₂, R₃ and R₄ taken independentlyof each other represent at least one oxygenated substituent; or R, R₂,R₃ and R₄ taken as an adjacent pair is methylenedioxy and the opticalantipodes thereof.

The combination of material from Group I and Group II is even furtherenhanced in its ability to alleviate psoriasis, as to time orconcentration of the material from Group I or Group II which is requiredto be effective, by the inclusion in the combination of aglucocorticoid. The expression "glucocorticoid" refers to a naturallyoccurring product of the adrenal cortex, or a synthetic analog thereofpossessing anti-inflammatory activity and minimal or nomineralocorticoid activity or sex steroid activity. Of the naturalglucocorticoids, one may use for example, hydrocortisone or thesynthetic glucocorticoids such as methyl prednisolone acetate(Prednisone) for oral application or triamcinolone for topical therapy.

The quantity of the compounds from Groups I or II to be used in thecompositions of this invention for administration topically,parenterally or systemically ranges from about 0.1% to about 10% w/vtopically; from about 0.1% to about 10% w/v parenterally or orally. Theamount of each of the materials from Groups I and II or any particularcomposition may be varied over a wide range depending upon the severityof the psoriasis, the patient's reaction to drugs, as above generallydescribed in connection with the over-all objective of safety ofadministration; the quantity of each of the materials from Group I andGroup II also varies as a function of degree of synergism which resultsfrom a particular combination of materials that is selected with theover-all objective being the selection of the minimal quantity of eachmaterial of the combination which will provide alleviation of thepsoriasis in the particular patient. For example, the degree ofsynergism exhibited by the combination of isoproterenol and theophyllineexceeds the synergism resulting from the combination of isoproterenoland caffeine.

Thus, the quantity of isoproterenol and theophylline may satisfactorilyrange from one-hundredth of the amount of isoproterenol which isrequired to activate the epidermal adenolate cyclase to a degreesufficient to alleviate psoriasis up to an amount of about one-third thequantity of isoproterenol which is effective for that purpose, and thequantity of theophylline may satisfactorily vary from aboutone-hundredth of the amount of theophylline which is required to inhibitepidermal phosphodiasterase to a degree sufficient to alleviatepsoriasis when applied separately, up to an amount of about one-thirdthe quantity of theophylline sufficient to effectively alleviatepsoriasis. In contrast, the range for isoproterenol in combination withcaffeine may satisfactorily vary from about one-fifth up to aboutone-third of the amount of isoproterenol which is required to alleviatepsoriasis when applied alone, in combination with about one-fifth up toabout one-third of the amount of caffeine required to effectivelyinhibit epidermal phosphodiesterase when applied alone, in order toachieve the synergistic cooperation to alleviate psoriasis whenadministered in combination. In general, the minimum quantity of theselected material from Group I may satisfactorily form about 1/100th toabout 1/3rd of the amount of that material which is effective toalleviate psoriasis when applied alone and the amount of the materialselected from Group II may satisfactorily vary from about 1/100th toabout 1/3rd of the amount of that material which is effective toalleviate psoriasis when applied alone. When the combination alsoincludes a permissive dose of a glucocorticoid, the quantities of theselected material from Group I and from Group II may each be decreased,or one of them may be decreased to as much as one-half of its previouslyselected effective concentration. From the standpoint of the greatestcombination or safety and effectiveness it is preferred that thecombination include a glucocorticoid. In the presence of a permissivedose of a glucocorticoid in the composition, the quantities of thematerial selected from Group I may vary from about 1/100th to about1/3rd of the amount of that selected compound which is effective toalleviate psoriasis when applied alone and the amount of the materialselected from Group II may vary from about 1/100th to about 1/3rd of theamount effective to alleviate psoriasis when applied alone. In mostinstances, it is preferred to slightly exceed the minimum quantitydetermined to be effective and to produce the desired synergistic resultin any given composition, for example, it is desirable to employ 1/4thto 1/3rd more of each of the compounds from Group I and Group II whichis established as the minimum effective composition for a given patientsince such composition has wider general utility and exhibitssatisfactory safety characteristics for a wide range of psoriasispatients.

I claim:
 1. A process for alleviating proliferative skin diseases which comprises administering to the afflicted human or animal a composition containing as its active component at least one of the compounds selected from the groups consisting of:1. Xanthines of the formula ##STR22## wherein R and R₁ are selected from the group consisting of H, alkyl and hydroxyalkyl containing 1-7 carbon atoms, cycloalkyl containing 3-7 carbon atoms and aralkyl wherein the alkyl portion contains 1-7 carbon atoms, R₂ is selected from the group consisting of H, alkyl (1-4), and a complex with ethylenediamine, and Y is selected from the group consisting of H and thiol; and
 2. 2. Thioxanthines of the formula ##STR23## wherein R₁ is selected from the group consisting of methyl, ethyl, propyl and -CH₂ -CH═CH₂ ; R₂ is selected from the group consisting of methyl, ethyl, propyl, -CH₂ CH═CH₂, isopropyl, isobutyl, CH₂ CCH₃ ═CH₂, pentyl, 3-methoxy-propyl, 2-methyl-butyl, hexyl, benzyl, phenyl, phenethyl, and furfuryl; R₃ is selected from the group consisting of hydrogen, methyl and ethyl;said compounds being in association with a pharmaceutical carrier wherein said active component is present in an amount in the range of about 0.1 to about 15% w/v which is effective to alleviate a proliferative skin disease.
 2. A process in accordance with claim 1, wherein said active component is at least one of the compounds selected from Group
 1. 3. A process in accordance with claim 1, wherein said active component is at least one compound selected from Group
 2. 4. A process in accordance with claim 1, wherein said active component is administered in conjunction with a permissive dosage of a glucocorticoid. 